Specialized intestinal metaplasia, dysplasia, and cancer of the esophagus and esophagogastric junction: Prevalence and clinical data
Specialized intestinal metaplasia, dysplasia, and cancer of the esophagus and esophagogastric junction: Prevalence and clinical data
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DOI：
10.1016/s0016-5085(99)70123-x
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发表时间：
1999-02-01
期刊：
影响因子：
29.4
通讯作者：
Wong, RKH
中科院分区：
文献类型：
--
作者：
Hirota, WK;Loughney, TM;Wong, RKH
背景与目的：食管及食管胃交界处腺癌（EGJ）呈上升趋势，最早病变为特化肠化生（SIM）。本研究确定了食管和EGJ中SIM、发育不良和癌症患者的患病率和人口统计学特征。方法：取鳞状柱交界处（SCJ）远端和鳞状柱交界处（SCJ）近端任何粉红色粘膜舌两个顺行活检标本。患者在内镜和组织学上分为长段（LSBE）或短段巴雷特食管（SSBE）、EGJ- sim或正常EGJ。结果：在研究的889例患者中，56例接受了食管十二指肠镜筛查或监测，未包括在患病率计算中。SIM的总体患病率为13.2%，其中LSBE为1.6%，SSBE为6.0%，EGJ-SIM为5.6%。31%的LSBE、10%的SSBE和6.4%的EGJ-SIM患者存在发育不良或癌症（P≤0.043）。2例癌症与LSBE相关，1例与SSBE相关，1例与EGJ-SIM相关。LSBE和SSBE患者以白人（P小于等于0.001）、男性（P小于等于0.009）和吸烟者（P小于等于0.004）为主，LSBE患者有较长的胃灼热史（P小于等于0.009）。EGJ-SIM患者的性别和种族与对照组相似，且年龄较大（P小于等于0.05），饮酒量较少（P小于等于0.02），幽门螺杆菌感染率较高（P小于等于0.05）。结论：SSBE和EGJ-SIM的患病率相似，但各实体的患病率是LSBE的3.5倍。然而，非典型增生在LSBE中的患病率是SSBE的2倍，是EGJ-SIM的4倍。人口统计学上，EGJ-SIM患者与Barrett食管患者不同，其幽门螺杆菌感染的患病率更高。这些数据有助于解释食管远端和EGJ腺癌发病率增加的原因。
Background & Aims: Adenocarcinoma of the esophagus and esophagogastric junction (EGJ) is increasing, the earliest lesion being specialized intestinal metaplasia (SIM). This study determined the prevalence and demographic features of patients with SIM, dysplasia, and cancer in the esophagus and EGJ. Methods: Two antegrade biopsy specimens were taken distal to the squamocolumnar junction (SCJ) and any tongues of pink mucosa proximal to the SCJ. Patients were categorized endoscopically and histologically as having long-segment (LSBE) or short-segment Barrett's esophagus (SSBE), EGJ-SIM, or a normal EGJ. Results: Of 889 patients studied, 56 were undergoing esophagoduodenoscopy screening or surveillance and were not included in the prevalence calculation. The overall prevalence of SIM was 13.2%, with 1.6% LSBE, 6.0% SSBE, and 5.6% EGJ-SIM. Dysplasia or cancer was noted in 31% of LSBE, 10% of SSBE, and 6.4% of EGJ-SIM patients (P less than or equal to 0.043). Two cancers were associated with LSBE, 1 with SSBE, and 1 with EGJ-SIM. Patients with LSBE and SSBE were predominantly white (P less than or equal to 0.001), male (P less than or equal to 0.009), and smokers (P less than or equal to 0.004), with LSBE patients having a longer history of heartburn (P less than or equal to 0.009). In contrast, patients with EGJ-SIM were similar in gender and ethnicity to the reference group, tended to be older (P less than or equal to 0.05), drank less alcohol (P less than or equal to 0.02), and had a higher prevalence of Helicobacter pylori infection (P less than or equal to 0.05). Conclusions: The prevalence of SSBE and EGJ-SIM is similar, but each entity is 3.5 times more prevalent than LSBE. However, the prevalence of dysplasia in LSBE is 2 times greater than in SSBE and 4 times greater than in EGJ-SIM. Demographically, EGJ-SIM patients are different from patients with Barrett's esophagus and have a higher prevalence of H. pylori infection. These data help to explain the increasing incidence of adenocarcinoma of the distal esophagus and EGJ.